international journal of medical informatics 77 ( 2 0 0 8 ) 787–808 journal homepage: www.intl.elsevierhealth.com/journals/ijmi Review Computer-based execution of clinical guidelines: A review David Isern * , Antonio Moreno University Rovira i Virgili, Department of Computer Science and Mathematics, Intelligent Technologies for Advanced Knowledge Acquisition Research Group, iTAKA, Av Països Catalans, 26, 43007 Tarragona, Catalonia, Spain article info Article history: Received 31 October 2007 Received in revised form 28 May 2008 Accepted 29 May 2008 Keywords: Clinical practice guideline Patient care management Decision-support systems, Clinical Decision making, Computer-assisted abstract Purpose: Clinical guidelines are useful tools to standardize and improve health care. The automation of the guideline execution process is a basic step towards its widespread use in medical centres. This paper presents an analysis and a comparison of eight systems that allow the enactment of clinical guidelines in a (semi) automatic fashion. Methods: This paper presents a review of the literature (2000–2007) collected from medical databases as well as international conferences in the medical informatics area. Results: Eight systems containing a guideline execution engine were selected. The language used to represent the guidelines as well as the architecture of these systems were compared. Different aspects have been assessed for each system, such as the integration with exter- nal elements or the coordination mechanisms used in the execution of clinical guidelines. Security and terminology issues complement the above study. Conclusions: Although these systems could be beneficial for clinicians and patients, it is an ongoing research area, and they are not yet fully implemented and integrated into existing careflow management systems and hence used in daily practice in health care institutions. © 2008 Elsevier Ireland Ltd. All rights reserved. Contents 1. Introduction .................................................................................................................. 788 2. Guideline execution engines ................................................................................................ 789 2.1. Arezzo TM .............................................................................................................. 790 2.1.1. Clinical guideline representation ............................................................................ 790 2.1.2. Architecture .................................................................................................. 790 2.2. Digital Electronic Guideline Library (DeGeL) ......................................................................... 790 2.2.1. Clinical guideline representation ............................................................................ 791 2.2.2. Architecture .................................................................................................. 792 2.3. GuideLine Acquisition, Representation and Execution (GLARE) .................................................... 792 2.3.1. Clinical guideline representation ............................................................................ 793 2.3.2. Architecture .................................................................................................. 794 2.4. GLIF3 Guideline Execution Engine (GLEE) ............................................................................ 794 2.4.1. Clinical guideline representation ............................................................................ 794 ∗ Corresponding author. Tel.: +34 977256563; fax: +34 977559710. E-mail addresses: david.isern@urv.cat (D. Isern), antonio.moreno@urv.cat (A. Moreno). 1386-5056/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2008.05.010